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Recovery Examiner


The successful candidate will be talented and motivated with outstanding data entry skills, able to multi-task and problem solve. The ideal candidate will be timely, self-motivated, hard-working, and organized. This candidate will be reviewing, requesting, and keeping record of claim refunds accurately using Access, Excel, Word, EZ Cap, and medical claims information. The candidate will need to be detail oriented to find inaccuracies, work well with large databases and calculating figures, use good communication skills to coordinate with other departments and also support the supervisor with day to day functions of the team.

Duties and Responsibilities

  • Process and post all daily refund checks received.
  • Prepares weekly and monthly reports to management of monthly refund requests and refunds received.
  • Prepares monthly reports to management and IPA analysts of reconciled reports of refund checks with Accounts Receivables.
  • Review refund requests for correct amount and reason.
  • Extract and report claim information for data tracking.
  • Preparation and mailing of refund request letters to providers.
  • Updating claim notes and documentation with refund requests and refunds received information.
  • Reviewing, report, and re-request letters of overpayment sent out 30 or more days.
  • Investigate and follow up on claims issues regarding overpayments.
  • Verify providers pending claims for recoupment by offset.
  • Recover money owed by providers on claims by offset.
  • Investigate and follow up on provider requests.
  • Coordinate daily with multiple departments: claims, A/R, IT, Provider services, eligibility, and others for claims and overpayment information.
  • Facilitate calls as needed to verify and/or research claims refund information.
  • Perform other related duties as assigned or requested.

Minimum Job Requirements:

AA degree or an equivalent combination of education, training, and experience is required.

Knowledge, Skills, and Abilities Required:

  • Experience in claims processing/adjusting, health plan, or medical terminology a plus.
  • Demonstrates strong understanding and experience using Excel.
  • Competency in MS Office and PC skills required.
  • Demonstrate organizational, interpersonal and communication skills.
  • Ability to perform multiple tasks while maintaining production and quality standards.

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Job title: Recovery Examiner

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